The politics of the polio vaccine in India.

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The politics of polioPushpa M. Bhargava

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Even the appropriate WHO document clearly states that there is evidence that OPV

has not worked in developing countries.

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That Sabin’s oral polio vaccine (OPV) has not been able to eradicate polio in

our country, is now well established (inter alia, Economic and Political Weekly,

4-11-06, p. 4538-4540; and 23-12-06, p.5229-5237; Tehelka, 11-11-06, p.8-9; The

Hindu, Hyderabad, November 13, 2006, p..11; Down to Earth, 31-12-06, p.24-31;

Conclusions Recommendations of a National Consultative Meeting organised by Ind

ian Medical Association in New Delhi on May 14, 2006; Editorial in the Indian

Journal of Medical Research, (IJMR), January 2007, p. 1-4; and numerous other

articles in some of the world’s best known scientific journals, such as

Science.)

 

[i do not subscribe to the theory that the IPV is in any way a better choice

than the OPV. It is like comparing one monster to another; all cases of polio in

the developed countries are today attributed to the IPV advocated here which can

also cause the dreaded paralytic state " Guillain Barre Syndrome " . The

first positive step should be to study the disease again with renewed

intensity to find out the real cause. And now that the OPV has been repeatedly

exposed I would like to talk again about the issue of compensation to the OPV

paralysed children who may number more than a lakh as per unofficial sources,

(The Telegraph quoted the figure of 3 lakhs in 2006). In the US recently a case

of OPV induced paralysis appeared 16 years after taking the vaccine. Is there

any such long term follow up in India? There is no other option, vaccines should

go, sense should prevail.. We and our children have suffered enough of this

cruel and uncivillised, definitely

unscientific,  intervention - Jagannath]

 

 

Not only that the cases of non–polio acute flaccid paralysis (AFP) in those

vaccinated with OPV have shown a dramatic rise. It appears that in 2005, in

Uttar Pradesh alone, 4,800 had residual paralysis, or died after acquiring

non-polio AFP, in comparison to the all-India figure of 4,793 polio cases in

1994; the 2006 data, after six doses of monovalent OPV, are worse. The

infructuous expenditure on the OPV programme would probably run into thousands

of crores.

 

The pity of it is that all this was anticipated (Bhargava, The Hindu, December

12, 1999 ), and that we could have easily eradicated polio from our country by

now. We did not do so because our successive governments and those who worked

for them in responsible positions such as Secretaries and Joint Secretaries in

the Ministry of Health, Directors-General of Medical and Health Services and

even of the ICMR, were primarily (exclusively?) committed to personal and

certain foreign interests and not to the cause of polio eradication. Here is the

story with which I was, in the initial stages, connected.

 Two types of vaccines

There have been two types of vaccines available against polio: the injectable

Salk vaccine (IPV) and the oral Sabin vaccine (OPV) using an attenuated live

virus.. Till the early 1980s, OPV was used in the developed countries to

maintain the polio-free status that had been largely achieved through the use of

IPV beginning the 1950s. By 1988, Jonas Salk (one of the most celebrated

scientists of the last century who made the first successful polio vaccine, the

IPV) had developed an enhanced potency injectable vaccine (M-IPV). In a letter

dated December 1, 1988 to me, he wrote, “It is urgent that the incidence [of

polio] be reduced as rapidly as possible. A simple way would be to administer a

single dose of the enhanced potency IPV (M-IPV), to all those of six months of

age or over who may have already received one or more doses of OPV (some of whom

we know, from experience may not have been protected), and to those of the same

age who may not have been

previously immunised against polio. A single dose of M-IPV of sufficient

potency will induce antibody and/or immunologic memory in nearly all infants of

that age. For infants less than six months of age who still possess maternal

antibody, two doses, preferably, one with DTP are necessary.†I had forwarded

this letter to everyone concerned in the country with the polio vaccination

programme at that time, but no one took any note of it.

 Evidence against OPV

Even before I had received the above-mentioned letter from Jonas Salk, at a

meeting held in Delhi in March 1988, convened by Sam Pitroda, the then Adviser

to the Prime Minister for National Technology Missions, overwhelming evidence

was presented that OPV had not worked in India (Bhargava, The Hindu, December

12, 1999 ). Virtually every one concerned with polio was present at this meeting

at which an unambiguous decision was taken to shift to IPV.

 

I quote from the official minutes of this meeting:

 

“Expedite establishment of M-IPV programme. On moral grounds and considering

the involvement of the lives of our children, cost shall be no consideration.

Indigenous production of IPV before 1991 shall be aimed at.†“Whenever

children in large numbers are dying, getting afflicted with polio, the empty and

hollow argument of their being used as guinea pigs cannot be accepted.†“As

new M-IPV programme ramps up, the OPV will ramp down.†Although IPV has always

been more expensive than OPV, this is compensated by the fact that one may need

to take only one or at most two doses of IPV whereas, in the case of OPV, the

number of doses could be above ten.

 

It was clear that, for some time, OPV will continue to be with us. In fact, the

then Secretary of the Department of Biotechnology (DBT), S. Ramachandran, had

been earlier to the Soviet Union and, with their help, a factory (BIBCOL) to

produce OPV was set up in Bulandshahr.

 

In keeping with the decision of the 1988 meeting — the only meeting of experts

and concerned people so far convened by the government in regard to polio

vaccination programme — another company called Indian Vaccine Corporation Ltd

(IVCOL) was set up with a capital outlay of Rs. 90 crores. Both DBT and the

Indian Petrochemicals Ltd. of Baroda had equity in it even though the majority

shares belonged to Institut Merieux, one of the world’s largest, most reliable

and respected vaccine producers that was committed to produce M-IPV which was

far more heat-stable than OPV.

 Obliging WHO

But we hadn’t reckoned with our primary commitment to the interests of the

developed countries. As already mentioned, by this time the West had decided to

replace OPV with M-IPV. Therefore, market had to be found for OPV. WHO advised

that developed countries use IPV, while developing countries use OPV. For us to

oblige WHO, two steps were necessary: (1) that BIBCOL produces no OPV of its

own; and (2) India reverses its decision to gradually shift to IPV. Both the

steps were taken. BIBCOL has not produced a single dose of OPV till today, and

the Ministry of Health decided soon after the March 1988 meeting, without any

further consultations, to shift permanently to OPV. Consequently IVCOL was

closed down after incurring substantial expenditure, and a number of senior

officers of the above Ministry got plum U.N. jobs with tax-free dollar salaries,

after retirement.

 

It is particularly interesting that at a conference jointly organised by the

International Comparative Virology Organisation and the WHO in New Delhi, in

January 1992, experts from all over the world indicated the preference of IPV

over OPV for any plans of eradication of polio in developing countries.

 Problem continues

An interesting question that one may, therefore, ask is: if we really felt that

there was a strong scientific case for using OPV (which there wasn’t), why did

we not make it ourselves. The answer is that this wouldn’t have served the

foreign interests to whom we had sold ourselves, ignoring the interests of our

own people and the sane advice of our own experts based on incontrovertible

evidence. It is amusing in this context that even the appropriate WHO document

clearly states that there is evidence that OPV has not worked in developing

countries.

 

The 64,000-rupee question now is: would the government wake up and get out of

the clutches of WHO so that it may serve our interests and not the interest of

powers that be outside India? And if it needs endorsement from a foreign

channel, it may read the article by V.K. Bhasin in January 2008 issue of Nature

Biotechnology, Nature being perhaps the world’s best-known and most respected

scientific periodical. The article says that, in 2006, there were 1,600 cases of

OPV–induced polio plus a large number of cases of AFP from which virus was not

cultured.

So, the problem continues. But who cares! Polio is not a disease of

billionaires.(Dr. P.M. Bhargava is former vice-chairman, National Knowledge

Commission.)

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  " It is now 30 years since I have been confining myself to the treatment

ofchronic diseases. During those 30 years I have run against so many histories

of littlechildren who had never seen a sick day until they were vaccinated and

who, in the severalyears that have followed, have never seen a well day since. I

couldn't put my finger onthe disease they have. They just weren't strong. Their

resistance was gone. They wereperfectly well before they were vaccinated. They

have never been well since. " ---Dr. Hay

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